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Headline: “In previous versions of the regulations, pharmacies were to distribute the product just like other medications, provoking concern from pharmacists, who expressed concerns about dispensing a product without sufficient research.” “Physicians and pharmacists alike questioned the regulatory changes, saying there is little evidence that medical marijuana is either effective or safe.” Read more: http://www.ctvnews.ca/health/health-headlines/canada-s-new-medical-marijuana- rules-cut-homegrowers-pharmacists-out

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Conclusions Reduction in pain (placebo vs 9.4% THC) – Trials for other medications in neuropathic pain have shown greater reduction – Patient populations may be different as these were refractory individuals Further studies required to study higher doses and more long term effects CMAJ 2010; 182: 1515–21.

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Conclusion A statistically significant reduction in pain was noted using the linear mixed model – Clinical significance of this reduction unclear ADRs clearly noted regarding cognitive impairment and psychotropic effects – Overall patients found the benefits outweighed the ADRs as they rated the drugs as having “good drug effects” and there were no withdrawals from the study J Pain 2008; 9: 506–21.

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Overall Conclusions Some RCT data to support the use of smoked cannabis for refractory neuropathic pain – Evidence limited to short duration, small studies ADRs always must be considered and were significantly present in the studies Logistics of administration (smoking) and prescribing challenging

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Recommendations Very difficult to recommend the use of smoked cannabis due to limited duration of trials and risk of unblinding leading to bias – Would not recommend inhaled cannabis at this time

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Smoked cannabis at maximally tolerated doses significantly reduced neuropathic pain in HIV patients compared to placebo when added to established pain regimes Cannabis may be an option for intractable neuropathic pain in HIV patients – The ADRs and logistical challenges of administration must be considered Conclusions

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Health Canada Changes By April, 2014: Full implementation of new Marijuana Medical Access Program – Health Canada no longer producing or selling marijuana – Access to marijuana for medical purposes must be obtained from a licensed producer competitive industry set own prices sell a variety of strains subject to security requirements and inspections must adhere to good manufacturing practices Health Canada. Backgrounder - Proposed Marihuana for Medical Purposes Regulations - Transitioning to a New System http://www.hc-sc.gc.ca/ahc-asc/media/nr-cp/_2012/2012-193bka-eng.php